Provider Demographics
NPI:1053429472
Name:AVIGAN, MICHELLE LYNN (PHD)
Entity type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:LYNN
Last Name:AVIGAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:11 KNIFE SHOP LN
Mailing Address - Street 2:
Mailing Address - City:SHARON
Mailing Address - State:MA
Mailing Address - Zip Code:02067
Mailing Address - Country:US
Mailing Address - Phone:781-784-1792
Mailing Address - Fax:781-784-1792
Practice Address - Street 1:1040 GREAT PLAIN AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:NEEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02492-2565
Practice Address - Country:US
Practice Address - Phone:781-856-8727
Practice Address - Fax:781-449-3134
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-27
Last Update Date:2016-06-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA7165103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAW50554Medicare ID - Type Unspecified